The topic I am writing about is elbow injuries, surgery and the therapy that takes place after the
surgery. The most common injury that baseball pitchers get is the tearing of the medial
collateral ligament. 26% percent of all injuries sustained by Major League baseball pitchers
occurred at the elbow joint1. There wasn’t that many cases of that injury years ago but now that
kids are starting to pitch a lot earlier in their lives, they are starting to wear out their elbows.
According to Healio Orthopedics case study “ Anconeus Epitrochlearis as a Source of Medial
Elbow Pain in Baseball pitchers” medial elbow pain is reported In 18% to 69% of baseball
players aged of 9 to 19 years. This is due to the large valgus stresses focused on the medial side
of the elbow during overhead activities2.
When considering surgery, the surgeon must consider the athlete’s demands, goals, and
expectations along with the degree of the MCL injury. They first try non-surgical treatment
which consist of 6 weeks of rest from throwing and doing flexor-pronator strengthening. If this
doesn’t work then surgery is the next option. This is called “ MCL reconstruction”. There are
three different reconstruction techniques. The first one is called “ modified jobe technique”.
The second one is called “ Docking Technique”. It modifies the jobe technique further,
simplifying graft passage, tensioning and fixation. The third one is called “ Hybrid Interface
Screw Fixation Technique”. This technique uses interface screw fixation. The palmaris longus is
the most commonly used graft choice, but since its absent in 25% of the population, other
tendons have to be used3.
After the surgery is complete, there is a long road of recovery and therapy. The patient
is in a splint for 10 days to let the skin and soft tissue heal. After 4 to 6 weeks, they can begin
strengthening exercises while avoiding valgus stress until after 4 months after surgery. After the
four months, they can start throwing again but only for a short time and distance. After 5
months, they can throw a more and a little farther. At 7 months they can go to a graduated
program of range-of-motion, strengthening, and total body conditioning. During the eighth and
ninth month, they can throw at 70% velocity. By one year after surgery they can return to
competitive play if there is no pain in their shoulder, forearm or elbow3.
There is a lot of therapy techniques that they do for elbow pain and surgery. The one
thing that they are trying is platelet rich therapies. These therapies are being used for the
treatment of musculoskeletal soft tissue injuries such as ligament, muscle and tendon tears and
tendinopathies. Platelet rich therapies are produced by centrifuging a quantity of the patients
own blood and extracting the active, platelet rich, fraction. The fraction is applied to the injured
tissue. They help with growth factors that assist in repair and regeneration of tissue 5.
There are other more common therapies that they do. They try regaining range of
motion, they do stretching , joint mobilization, increasing elbow extension, increasing elbow
flexion. They also do isokinetic exercise. Isokinetic resistance is characterized by a constant,
fixed-velocity, and accommodative resistance through a range of motion 4.
1. in Glenohumeral passive range of motion increase risk of elbow injury in pro
baseball pitchers: a prospective study
American journal sports Med 2014 Sep, 42(9): 2075-81. Doi:
10.1177/0363546514538391. Epub 2014 June 18
2. Ancaneus Epitrochlearis as a source of medial elbow pain in baseball pitchers.
Academic Journal issn: 0147-7447 pmid: 22784916
3. The Athletes Elbow, Levine, William N.
American Academy of Orthopedic Surgeons c2008 VII p.: 97808892084550
4. The Elbow in Sport: injury, treatment, and rehabilitation: Ellenbecker, Todd s.
RD558.E45 1997
5. Platelet-rich therapies for musculoskeletal soft tissue injuries: Moraes, Vinicius Y.
Lenza, Mario, Tamaoki jun marcel, Faloppa Flavio, Belloti, carlos joao. Published
Online: 29 APR 2014: DOI: 10.1002